Environmental cleaning and disinfection of patient areas

The International Journal of Infectious Diseases has published a new article on environmental cleaning and disinfection of patient areas. The authors undertook a narrative review of the literature comprises hospital surfaces, other potential reservoirs of infection and the monitoring of cleaning.  Their review also considers antimicrobial ‘self-cleaning’ surfaces, cleaning robots ‘touchless’ technologies and also discuss other interventions to improve manual cleaning.   They also summarise  the strategies for environmental cleaning and disinfection of patient areas in a table.  For the researchers,  human factors will ultimately determine the quality of environmental cleaning in the hospital and will remain the patient’s best defense against invisible threats from the hospital environment.

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Abstract

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

Full reference: Doll, M., Stevens, M., &  Bearman, G. |Environmental cleaning and disinfection of patient areas | International Journal of Infectious Diseases |57| 2018 | P.52-57| Doi https://doi.org/10.1016/j.ijid.2017.10.014

The full article is available for NHS Athens users, it can be accessed here 

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Is pulsed the answer to treatment of Clostridium difficile infection?

Antibiotic treatment of Clostridium difficile infection has been plagued by high rates of recurrent diarrhoea attributed to C difficile and requiring retreatment, often repeatedly. In the latest edition of The Lancet Infectious Diseases, Benoit Guery and colleagues describe a novel dosing regimen for fidaxomicin in which the standard 200 mg, 20-dose, 10-day regimen is extended (the EXTEND study) by giving 200 mg twice daily for the first 5 days, followed by 200 mg every-other-day for an additional 20 days. The comparator regimen was standard-dose vancomycin (125 mg four times daily for 10 days), which is the same comparator dose that was used in two phase 3 licensing trials of standard-dose fidaxomicin (200 mg twice daily for 10 days). (The Lancet Infectious Diseases)

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Further information can be found  at The Lancet Infectious Diseases 

Full reference: Gerding, D. N| (2017) | Is pulsed dosing the answer to treatment of Clostridium difficile infection?| The Lancet Infectious Diseases | Published online

The full article is available for Rotherham NHS staff to request here 

International study finds 1 in 8 patients have an infection following common procedures

A worldwide study which studied the incidence of surgical site infection (SSI) in over 12,000 patients who had gastro-intestinal surgery, across 66 countries has been published in The Lancet. The researchers quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. The findings of the prospective, international study included 1 in 8 patients experiencing infection post-operation for common procedures such as appendix removal.  In more than 20% of cases, patients developed infections which antibiotics should have protected them from

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Abstract 
Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries throughout the world.
Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries
were stratified into high-income, middle-income, and low-income groups according to the UN’s Human Development Index (HDI).  The primary outcome measure was  the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models.

Findings Between Jan 4, 2016, and July 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries).
In total, 1538 (12·3%) patients  had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI.
The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries.

Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance.

The full text article can be downloaded from The Lancet 

Infection outbreaks could be reduced by copper coated uniforms say University of Manchester scientists

Full reference :Sun, C. et al. |Durable and Washable Antibacterial Copper Nanoparticles Bridged by Surface Grafting Polymer Brushes on Cotton and Polymeric Materials| Journal of Nanomaterials|2018| DOI: 10.1155/2018/6546193
While the antibacterial properties of gold and silver are well known, and their effectiveness in reducing the growth of several microorganisms has been reported, the high cost of silver and gold has compelled material chemists to explore the possibility of using copper, as it has similar antimicrobial properties but is far less expensive. 

wire-2681887_1920Researchers from University of Manchester collaborated with Chinese scientists to create a ‘durable and washable, concrete like’ composite material made from antibacterial copper nanoparticles.  Rather than using the traditional process of copper coating the polymer brush technique (polymer surface grafting) to create a strong chemcial bond developed by team proved far more effective. They tested these nanoparticles on cotton and polyester as each material was brushed with the nanoparticles. The cotton and polyester coated-copper fabrics showed excellent antibacterial resistance against Staphylococcus aureus (S. aureus) and E. coli, even after being washed 30 times.

Abstract

To increase the durability of antibacterial coating on cotton and polymeric substrates, surface initiated grafting polymer brushes are introduced onto the substrates surface to bridge copper nanoparticles coatings and substrate. The morphologies of the composites consisting of the copper nanoparticles and polymer brushes were characterized with scanning electron microscopy (SEM).

It was found that copper nanoparticles were uniformly and firmly distributed on the surfaces of the substrates by the polymer brushes; meanwhile, the reinforced concrete-like structures were formed in the composite materials. The substrates coated by the copper nanoparticles showed the efficient antibacterial activity against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) even after washing by 30 cycles. The copper nanoparticles were tethered on the substrates by the strong chemical bonds, which led to the excellent washable fitness and durability. The change of the phase structure of the copper was analyzed to investigate the release mechanism of copper ions.

Full story at Science Daily

Related Infection Control Today Copper Coated Uniforms could Help Reduce Infection Transmission 

 

Soil sample analysis reveals new class of antibiotics

Scientists from Rockefeller University, New York have discovered a class of distinctive anitiboitics in environmental samples.  Tests show the compounds, called malacidins, annihilate several bacterial diseases that have become resistant to most existing antibiotics, including the superbug MRSA. As infectious diseases are the leading killer of humans worldwide, the team behind the discovery hope to be able to improve the drug’s effectiveness to exploit its full potential. 

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The researchers used a gene sequencing technique to analyse DNA extracted from more than 1,000 soil samples taken from across the US.  This led to the discovery of the malacidins, a distinctive class of antibiotics that are commonly encoded in soil microbiomes but have never been reported in culture-based natural products (NP)  discovery efforts.

The malacidins are active against multidrug-resistant pathogens, sterilize methicillinresistant Staphylococcus aureus skin infections in an animal wound model and did not select for resistance under laboratory conditions.

Full article at BBC News: New Antibiotic family discovered in dirt 

The full text article can be downloaded from Nature Microbiology

Full reference:  Hoover, B. M. | Culture- independent discovery of the  malacidins as
calcium-dependent antibiotics with activity against multidrug-resistant Gram-positive pathogens | Nature Microbiology | 2018| Doi: https://doi.org/10.1038/s41564-018-0110-1

NICE will not update guidance on Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (2015) NICE guideline NG15

 NICE (National Institute for Health and Care Excellence)  check their guidelines regularly to ensure they remain up to date. They have decided not to update the guideline on antimicrobial stewardship at this time. NICE based the decision on surveillance 2 years after the publication of NICE’s guideline on antimicrobial stewardship (NICE guideline NG15) in 2015. 

Reason for the decision

Assessing the evidence

For this guideline,  NICE checked any policy or other guidance documents that had been issued or updated since NICE guideline NG15 was published. They also checked any Cochrane reviews related to the guideline – this included any updates to the 4 Cochrane reviews used to inform the recommendations during development of the guideline, as well as any new Cochrane reviews published since October 2014 when the original search took place.  In addition, NICE also  checked for any relevant National Institute for Health Research (NIHR) Signals. Each piece of evidence was checked against the guideline recommendations to assess any potential impact.

The policy, Cochrane reviews and NIHR Signals NICE examined did not indicate a need to update the guideline, therefore we did not undertake a formal evidence review. Furthermore, members of the original guideline committee were in agreement that there had been no substantial changes to the evidence base that would affect the guideline at this point .

NICE also checked for any relevant ongoing studies, and the impact of any publications arising from these in future will be monitored.

Overall decision 

 After considering the evidence described above as well as the views of topic experts and stakeholders, NICE  proposes  to not update this guideline.

See how NICE made the decision for further information